Propofol vs midazolam for ICU sedation - A Canadian multicenter randomizedtrial

Study objectives: To determine whether sedation with propofol would lead to shorter times to tracheal extubation and ICU length of stay than sedation with midazolam. Design: Multicenter, randomized, open label. Setting: Four academic tertiary-care ICUs in Canada. Patients: Critically ill patients requiring continuous sedation while recei ving mechanical ventilation. Interventions: Random allocation by predicted requirement for mechanical ve ntilation (short sedation stratum, < 24 h; medium sedation stratum, <greate r than or equal to> 24 and < 72 h; and long sedation stratum, 72 h) to seda tion regimens utilizing propofol or midazolam. Measurements and results: Us ing an intention-to-treat analysis, patients randomized to receive propofol in the short sedation stratum (propofol, 21 patients; midazolam, 26 patien ts) and the long sedation stratum (propofol, 4 patients; midazolam, 10 pati ents) were extubated earlier (short sedation stratum: propofol, 5.6 h; mida zolam, 11.9 h; long sedation stratum: propofol, 8.4 h; midazolam, 46.8 h; p < 0.05). Pooled results showed that patients treated with propofol (n = 46 ) were extubated earlier than those treated with midazolam (n = 53) (6.7 vs 24.7 h, respectively; p < 0.05) following discontinuation of the sedation but were not discharged from ICU earlier (94.0 vs 63.7 h, respectively; p = 0.26), Propofol-treated patients spent a larger percentage of time at the target Ramsay sedation level than midazolam-treated patients (60.2% vs 44.0 %, respectively; p < 0.05) Using a treatment-received analysis, propofol se dation either did not differ from midazolam sedation in time to tracheal ex tubation or ICU discharge (sedation duration, < 24 h) or was associated wit h earlier tracheal extubation but longer time to ICU discharge (sedation du ration, <greater than or equal to> 24 h, < 72 h, or < 72 h). Conclusions: The use of propofol sedation allowed for more rapid tracheal e xtubation than when midazolam sedation was employed. This did not result in earlier ICU discharge.